Urethritis Empiric Therapy 

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Empiric therapeutic regimens for urethritis are outlined below, including those for the following [1, 2, 3, 4, 5, 6] :

If clinically-based diagnostic tools (eg, Gram-stain microscopy) are not available, treat patients with drug regimens effective against gonorrhea and Chlamydia, as follows:

Azithromycin 1 g PO in a single dose or doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy) plus

Ceftriaxone 250 mg IM in a single dose (strongly preferred) or cefixime 400 mg PO in a single dose (plus test-of-cure in 1 week)

Fluoroquinolones should not be used as empiric therapy because of increasing resistance of Neisseria gonorrhoeae isolates.

First-line regimens:

Azithromycin 1 g PO in a single dose or

Doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy)

Alternative regimens:

Erythromycin base 500 mg PO QID for 7d or

Erythromycin ethylsuccinate 800 mg PO QID for 7d

Ofloxacin 300 mg PO BID for 7d or

Levofloxacin 500 mg PO once daily for 7d

Recommended regimens:

Metronidazole 2 g PO in a single dose or

Tinidazole 2 g PO in a single dose plus azithromycin 1 g PO in a single dose

Recommendations include the following:

Sexual partners (within the preceding 60 d) of patients treated for nongonococcal urethritis should be referred for evaluation and treatment 

Patients with Chlamydia trachomatis should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy or until completion of a 7 d regimen

Patients with Neisseria gonorrhoeae should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy

Workowski KA, Berman SM. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4. 55:1-94. [Medline].

Centers for Disease Control and Prevention. Update to CDC’s sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007 Apr 13. 56(14):332-6. [Medline].

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59 (RR-12):1-110.

Terris MK, Sajadi KP. Urethritis. Medscape Reference. Available at http://emedicine.medscape.com/article/438091-overview. Accessed: August 10, 2009.

Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline].

Lau A, Bradshaw CS, Lewis D, Fairley CK, Chen MY, Kong FY, et al. The Efficacy of Azithromycin for the Treatment of Genital Mycoplasma genitalium: A Systematic Review and Meta-analysis. Clin Infect Dis. 2015 Nov 1. 61 (9):1389-99. [Medline].

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Urethritis Empiric Therapy 

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